Provider Demographics
NPI:1427409564
Name:WISER, WESLEY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JAMES
Last Name:WISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PURCHASE ST STE 269
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2101
Mailing Address - Country:US
Mailing Address - Phone:207-610-0425
Mailing Address - Fax:
Practice Address - Street 1:222 PURCHASE ST STE 269
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2101
Practice Address - Country:US
Practice Address - Phone:207-610-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295793208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice